Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Emergency physician Resa E. Lewiss and health care executive Jake Horowitz discuss their article, “Why women ER doctors earn $21,000 less than men.” They reveal staggering new data that shatters the myth that the gender pay gap does not exist in emergency medicine, showing how it persists even after controlling for hours, experience, and patient volume. Resa and Jake explore the hard numbers: women ER physicians earn $21,000 less annually, a salary disparity that widens to over $40,000 late in their careers. This is not about output, it is about systemic inequity in the health care system that contributes directly to physician burnout and attrition among women physicians. The discussion moves beyond the problem to focus on solutions, highlighting the critical need for pay transparency, hospital audits, and collective action to demand pay equity. Learn how data can expose the truth and finally help fix the systemic issues robbing women doctors of millions in career earnings.

Our presenting sponsor is Microsoft Dragon Copilot.

Microsoft Dragon Copilot, your AI assistant for clinical workflow, is transforming how clinicians work. Now you can streamline and customize documentation, surface information right at the point of care, and automate tasks with just a click.

Part of Microsoft Cloud for Healthcare, Dragon Copilot offers an extensible AI workspace and a single, integrated platform to help unlock new levels of efficiency. Plus, it’s backed by a proven track record and decades of clinical expertise, and it’s built on a foundation of trust.

It’s time to ease your administrative burdens and stay focused on what matters most with Dragon Copilot, your AI assistant for clinical workflow.

VISIT SPONSOR → https://aka.ms/kevinmd

SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended

Transcript

Kevin Pho: Hi. Welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Resa E. Lewiss, an emergency physician, and we introduce Jake Horowitz. He is the co-founder of the physician platform Off Call, and they are here to discuss the article “Why women ER doctors earn $21,000 less than men.” Resa and Jake, welcome to the show.

Jake Horowitz: Thank you for having us, Kevin. Great to be here.

Resa E. Lewiss: Great to be here.

Kevin Pho: All right. Let’s jump straight into this article. Jake, I believe this was published on Off Call. The study was there: “Why women ER doctors earn $21,000 less than men.” For those who didn’t get a chance to read that article, tell us what it is about.

Jake Horowitz: Yes, sure. Thank you for the opportunity. Off Call is a new platform for and by physicians to help bring about pay and workload transparency. We rely on anonymous and free submissions from any physician all across the U.S. What we do at Off Call is collect that data, analyze it over thousands of data points, and see where there are interesting trends or disparities across specialties and across different types of metrics.

We did a deep dive on emergency medicine, and honestly, the data that we looked at was really troubling. What we found is that if you take two emergency physicians who have similar training, work at the same hospital, are contracted to work the same number of hours, and see roughly the same number of patients (controlling for all of the confounders that one would want to think about), if one is a man and one is a woman, the woman will earn about $21,000 less each year than the male doctor.

The sub-headline, when you look at a bunch of the other data points, is equally problematic. If you look at hourly pay, even adjusted for workload, women earn $17 less per hour. If you look at career progression, we found that this widens over time. Mid-career female physicians earn $28,000 less, and later-career female physicians earn $40,000 less. Even if you look across different pay structures, such as productivity models or hourly or salaried models, men earn roughly $59,000 more than women in productivity-based pay models. Across every metric that you would want to see, and across all of the confounders that typically get brought up to explain this, what we found controlling for all of that is that very unfortunately in emergency medicine, there is a wide pay gap between male and women physicians.

Kevin Pho: Of course, we are going to talk about some of the potential root causes for that pay gap. But before I do, Jake, is this data something that is proprietary to Off Call? This isn’t publicly available. How is it different from something that you would get at MGMA, for instance?

Jake Horowitz: Great question. This is a new data set that we created at Off Call. For years, there have been platforms like MGMA and others that present salary data, but it has been hard to access for physicians and it has served more employers, frankly. That is part of why we wanted to create Off Call: to give physicians direct access to this data at any time, whenever they want it, whenever they need it. You can get that at Off Call.

There are salary surveys and social media groups and others who collect this data. What we wanted to do is present a way for physicians to find this data with high confidence for free across any specialty. That is what anybody who is listening to your show can get at Off Call today. That is what we are trying to do at Off Call: present the data, aggregate the data, and display the data in interesting ways so that people can actually learn what is happening with that kind of transparency.

Resa E. Lewiss: You’re an emergency physician. When you first read that finding that Jake described, tell us what your initial reactions were.

Resa E. Lewiss: That is a great question. What I will say is that I am not surprised and felt a little bit of “So what?” What I will say is that I have been a part of Off Call and believed in the mission of Off Call from the beginning. I was delighted when they ran the specific data on emergency medicine because, as I said, this is not new news. The publications that have demonstrated this salary gap go back 25 or more years: JAMA, Doximity, op-eds, etc.

I think what is inspiring and important is the shock that Jake and Graham had. It wasn’t because they didn’t believe the academic data, but there is something different when it is behind a paywall (literally or figuratively) and being published in the medical and scientific PubMed literature versus actually being out and publicly available. This is very, very, very powerful data. As much as I was thinking “Next, we are ready for solutions,” it is important to have more people speaking about those solutions.

I am really glad to see that the data sort of says the same thing that we have been hearing for decades. What is different is that this is new, this is 2025, and what Off Call is doing and has the ability to do is actually run this data for more than just emergency medicine. I think we are just going to see that every single specialty is going to demonstrate this because historically, every single medical specialty in the house of medicine has this gender salary gap.

Jake Horowitz: Such a great point. I do want to share with you, Kevin, and your listeners that you wouldn’t believe (or maybe Resa would believe) the messages that we got mostly from male physicians after we published this study. They were skeptical and said the typical thing that probably Resa and your female physician audience has heard time and time again: “Oh, well that is not in my hospital,” or “Oh, you couldn’t have looked at the hours or controlled for the hours correctly,” or “That is just not true.” When you look at hourly pay, they say: “That just doesn’t add up. I have never seen that. I have never talked to a female physician who has experienced that.”

I do think that is the point. Resa mentioned it: there have been studies shared before, and in a certain sense, reporting on this is not new. But in another sense, those comments reflect what is still deep-seated as an undercurrent of this conversation. People (male physicians, anyway) sort of have a reaction of “Not in my hospital” or “Not me” or “I can’t believe that that would be true because I have never heard it.” That is why we feel so passionate that bringing it out in the open and having these kinds of conversations on your show (and we are grateful that you are doing this and bringing visibility to it) will help expose people to what is really happening on the front lines.

Kevin Pho: Resa, when Jake said that some of the feedback from male physicians said that this doesn’t happen in my hospital, anecdotally, even before the study, I think that you implied that you have seen that pay disparity personally, or you have heard from your colleagues that there is a gender-based pay disparity that you have seen even before the study came out. Is that correct?

Resa E. Lewiss: That is more than correct. I have personal stories, but forget about my personal direct witness. I have been an indirect witness where things are explained away. I will even use the word gaslighting: “Oh, well it is because they want to be at home with family, taking care of young children, taking care of elderly parents,” or “Oh, it is because they take family leave.” It is sort of blaming the victim and explained away, which is the beauty of the data. Confounding variables were removed, and they still came up with this.

I also think it is powerful that Graham and Jake are the ones putting this out. People are like: “Oh wow. OK. What is in it for them?” Now, what is in it for them is they believe in pay transparency, and that is what they built the platform on. I have been hearing this behind closed doors for years. I think that is another difference. Some of these surveys ask employers what they are doing for salary transparency, whereas this has been flipped. The script is flipped, and these are people self-reporting. It doesn’t mean that it is not met with sometimes some fear, like “What if there is going to be retaliation?” or “What if somehow I get outed?” But this is sort of truth. This has been a persistent trend, and they are just sort of redoing it again. However, the audience is different, the timing is different, and perhaps the people amplifying the message are a little different.

Of course, I am glad the guys are talking to the guys because we actually need everybody at the table. We particularly need the people in power. In 2025, often the people in power are exactly the same people who were in power 20, 50, or 100 years ago. So they need to be speaking with themselves, and there needs to be pushback from people that have some of that power to say: “Nope, this is data. This is real, and this is not fair.”

Kevin Pho: Jake, as you looked at this data from the study, any potential causes that jumped out and any potential hidden causes that may not apparently be obvious? What were some of the explanations that may explain that disparity?

Jake Horowitz: When I dive deeper into this topic, what I realize is the problem is completely multifaceted, and it starts really early in physicians’ careers. It starts from residency and it starts from training. You can look at the top-line salary numbers, but you can also look at the subtle things that happen on a daily, weekly, and monthly basis from feedback and how feedback is delivered from male supervisors to female residents, and how that feedback differs if that person is a man versus a woman. Then you can look at reviews and how performance-based reviews based on that feedback differ if the person receiving the feedback is a male versus a female. Even in those kinds of settings and in those small subtle ways where the feedback a female doctor gets told versus what a male doctor gets told differs, you start to see examples of bias creep in.

That compounds. It starts early, and then over the course of your first contract (most physicians do not know that you can negotiate your first contract, and actually it is advised and a good idea to do so), fear particularly comes in for female physicians versus male physicians. Even more so, many female physicians will just accept the first contract that they are given. Those contracts then end up compounding over the course of a career. Over a 20-year career, a 30-year career, or a 40-year career, beyond when you have your first contract and then you are doing productivity metrics and bonuses and all these things that compound, you start to see the same path creep up over and over again.

I wish, Kevin, there was a one-size-fits-all answer to this, and a hospital executive could just look at a paper and say: “OK, great. We are going to make the same salary.” But unfortunately, it is pretty deep-seated and cultural from what I have seen and requires a very nuanced understanding of these different aspects of where this starts to creep in and happen over the course of a career.

Resa E. Lewiss: I am going to highlight and just jump in and say it. Really, if you look at starting salaries from the beginning, that is sort of a starting point. If that is the start line, so to speak, and you look at the growth over time, you are already at this gap. The data from Off Call basically highlights that over a lifetime, this could be a $600,000 difference. Other studies have shown a million-dollar difference, so this is real.

It is also about contributions to retirement. Another piece that plays a role is side gigs. Is your buddy giving you a side gig? Like, “Hey, give this sponsored talk,” or “Hey, review this case for medical-legal purposes and make sure you charge your hourly.” It is also about sort of the “on the golf course,” “in the locker room,” “at the bar” interactions: basically, some of the social activities where you get offered opportunities because you are in the room. It is kind of like I said: literally and figuratively about the paywall. It is literally and figuratively being invited into the room.

Kevin Pho: Resa, in terms of next steps, I am going to ask you a two-part question. The first scenario, of course, would be that initial contract because that disparity in the initial contract compounds over time. Talk about what new physicians or new female physicians can do when they have that first job. Then the second part is, I guess I am going to say in quotes, “corrective action.” If a hospital system sees a disparity, what would a practical corrective action plan even look like? Resa, why don’t you address those two points?

Resa E. Lewiss: Sure. So number one: Salary transparency, salary transparency, salary transparency. It seems like such a simple solution/ask, but there is so much protection that goes on within institutions. I have worked at one institution that said: “Oh, we fixed this years ago. There is no need to look at it again.” But there was a need to look at it again.

If we can somehow hold institutions, hospitals, and private organizations accountable for that transparency, that helps. I do think teaching people to negotiate is never bad; it is a really good tactic. Also, when you say to women: “You need to ask, you need to negotiate, you need to learn,” sometimes it is a little bit of blaming the victim and kind of “fixing the woman” rather than “fixing the problem.” So I think you can have both: a growth mindset to learn how to negotiate, but also create a system that works and is fair for everybody if you didn’t get that extra coaching or that inside scoop.

Another point that we bring up in what we wrote is about the power of organizations. Medical organizations can be powerful. They can put out statements. They can hold these organizations accountable in a way that we as individuals can’t. To be clear, we may have individual agency, but these institutions are bigger and more powerful than we are.

Lastly, I just think that part of what we thought would change over time really hasn’t. So I think we have to be creative about new ways to fix this challenge. I am a devotee of Off Call. I believe in what they are doing because just with what they published on emergency medicine and more recently on neurology, they have gotten more eyes, ears, and responses than I think has really happened in traditional scientific and medical publications. Sure, because of social media, but also because people are like: “Wow, I didn’t see a change. Wow, I have never seen this data.” For those of us who have been watching these data trends over time, we are shocked that people haven’t seen the data, but it just means it hasn’t really gotten in front of the people that have potentially a space and a place to make the change.

Kevin Pho: Resa, if a female physician discovers that there is a pay disparity between her and her male colleagues, what are some potential options they have?

Resa E. Lewiss: Great question, and this happens too commonly. A quick story: I know of two people who were hired to split a leadership position. It was their first new job out of completing training. They were hired, one woman and one man, and she by accident received his contract and realized that he was starting $10,000 higher than she was too.

To your question: I think when these things happen, there is a lot of fear and there is a lot of scarcity mindset in health care. That vertical hierarchy is real, and I think the fear is real. People think they are going to get in trouble.

So, number one: Speak to your personal board of directors. These are your go-to people that you trust that can help give you advice in your professional journey. Speak with them.

Number two: Figure out where it is safe to report these things. Sometimes it is your supervisor. Sometimes it is HR. Sometimes it is an outside organization that puts forth employment rights. Even working with an employment attorney is an option. Sometimes some people choose to go ahead and publish an op-ed in a major newspaper or something like that. There is no one way, but I think silence is not going to change or move the needle at all. Figure out outlets, but start with people you trust. Run it by them. Look at the organization. See if this is a pattern (which likely it is; it is probably not a one-off). Figure out if there is room to make change.

Kevin Pho: We are talking to Jake Horowitz and Resa Lewiss. Jake is the co-founder of the physician platform Off Call, and Resa is an emergency physician. They are talking about the KevinMD article “Why women ER doctors earn $21,000 less than men.” Now, I am going to ask each of you just to share some take-home messages that you want to leave with the KevinMD audience. Jake, why don’t we start with you?

Jake Horowitz: As a non-physician, when I saw this data, I was outraged. When any person goes in to see a doctor (I recently had the experience of going in to see the pediatric emergency room for my child), what they want is the best doctor possible to provide the best care. They want a doctor who is really focused, passionate, and excited about their job. What they don’t want is a physician who is feeling burned out, disgruntled, or like they are not paid fairly or treated well relative to their colleagues, and therefore cannot possibly provide the best care. If I have one message, it is that this data doesn’t just impact physicians; it impacts everybody. Everybody should want to see their doctor paid well, and everybody should want to see their doctor paid fairly. We as a society should want to see women physicians get paid equally to men and get paid well and fairly for what they do.

Kevin Pho: And Resa, we will end with you. Your take-home messages.

Resa E. Lewiss: I double down on everything that Jake just shared. I want to make a specific comment regarding intersectionality because this data didn’t break down the data by race or ethnoracial background. But when you run those numbers historically in articles, the salary disparities are even worse. I actually think safe, equitable, respectful work environments should at minimum demand pay equity because, as Jake said, that pay equity leads to better, safer patient care. There is nobody that doesn’t want the best medical care when they go and meet with a physician. So it just makes sense and it is good for everybody. Everybody wins.

Kevin Pho: Resa and Jake, thank you so much for sharing your perspective and insight. Thanks again for coming on the show.

Jake Horowitz: Thank you, Kevin.